Severe Facial Clefts in Acrofacial Dysostosis

Abstract

Mycophenolate mofetil may have contributed to or even caused acrofacial dysostosis phenotype and extensive clefting.

Treatment of Primary Systemic Vasculitis with the Inosine Monophosphate Dehydrogenase Inhibitor Mycophenolic Acid

“…Four of the live births manifested structural malformations including microtia, cleft lip and palate, short fingers and nail hypoplasia, and 1 neonatal death with multiple abnormalities. Similar abnormalities have also been described by other authors [71,72], leading to the recent proposal of a characteristic phenotype of mycophenolate embryopathy comprising cleft lip and palate and microtia [73]. …”

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

“…Previously, we found that following prednisolone (or unspecified corticosteroid) exposure, average pregnancy duration in the majority of randomized controlled trial (RCT), case-control, cohort and case-series studies (where reported) was usually term, at ≥37 weeks [ 43 , 51 , 84 , 85 , 88 , 92 , 94 , 96 , 101 , 102 , 104 , 105 ]. Other studies reporting ≤37-week delivery were confounded by factors such as maternal disease and concomitant medications [ 46 , 57 , 59 , 60 , 86 , 87 , 99 , 106 , 113 , 117 , 163 , 165 ]. Birth weights followed a similar pattern and were affected by preterm deliveries and confounding factors, as described above.…”

“…We previously reviewed data from 16 studies/reports [ 57 , 60 , 92 , 95 , 99 , 113 , 114 , 116 , 208 , 235–241 ] of 90 pregnancies exposed to MMF, mostly from renal transplant patients in whom there was concomitant exposure to prednisolone and tacrolimus. Increased rates of premature delivery, low birth weight and major congenital malformations were reported, including malformations typical for the previously described MMF embryopathy (including cleft lip and/or palate, microtia with aural atresia, micrognathia and ocular anomalies) [ 1 ].…”

A second delivery after heart transplantation – a case study

“…In the case of tacrolimus or ciclosporin monotherapy, folic acid supplementation during the first trimester should be conducted in accordance with the generally accepted guidelines. Mycophenolate mofetil and sirolimus should be discontinued approximately 6 weeks before a planned pregnancy due to the risk of fatal congenital defects in the fetus [ 19 ].…”